Provider Demographics
NPI:1548214646
Name:REYNOLDS, CARL H V (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:H
Last Name:REYNOLDS
Suffix:V
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:H
Other - Last Name:REYNOLDS
Other - Suffix:V
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:BOX 242
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-5067
Mailing Address - Fax:585-922-2908
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-5184
Practice Address - Fax:585-922-5914
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235612-1207RH0002X
NY235612208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02722865Medicaid
NY02722865Medicaid
NYRA9508Medicare PIN
NYJ400056914Medicare PIN